Jaundice

What is jaundice?

Bilirubin is a yellow-coloured substance which is responsible for the yellow colouration in your skin and the white outer layers of your eyeballs in jaundice. Bilirubin is produced as a waste by-product when red blood cells break down naturally during each 120-day cycle. Bilirubin is excreted from your body by the body’s waste disposal system when it is transported from your blood into your liver. This bilirubin combines with bile from your gallbladder, and the mixture exits the body through your urine and faeces. Usually, if this process has been completed, your urine will be light yellow and faeces brown. Infections or damage may interfere with this process, resulting in jaundice.

What causes jaundice?

There are three main types of jaundice: Hepatocellular jaundice, Haemolytic jaundice and Obstructive jaundice (which is our primary concern).

Hepatocelluar jaundice develops when your liver is injured or diseased.

Haemolytic jaundice develops when haemolysis, an accelerated breakdown of red blood cells, occur as this leads to increased bilirubin production in your body.

Obstructive jaundice develops when a gallstone passes from your gallbladder via the cystic duct into the bile duct. This stone blocks the bile duct and the passage of bile into the intestine. The bile will then be absorbed into your bloodstream instead. Without the necessary bile secreted into your liver to combine with bilirubin, bilirubin is unable to be excreted by the body and thus remains in the body.

Excess bilirubin in the body causes patients to have a yellow discolouration of the whites of their eyes and skin which is associated with severe itchiness. In most cases, it requires an emergency procedure by your surgeon to surgically remove the gallstones from your bile duct. In some cases, the gallstone eventually passes into their intestine.

How do I know if I have jaundice?

Common signs and symptoms of jaundice include:

  • Yellowing of the whites of your eyes and skin
  • Itchiness
  • Fatigue
  • Dark urine and light stools
  • Fever
  • Vomiting
  • Abdominal pain, which may indicate blockage of bile duct
  • Unexplained weight loss

Do seek medical attention immediately should you present the symptoms mentioned above.

How is jaundice diagnosed?

Your doctor will perform a physical examination to diagnose you with jaundice. Besides the yellowing of your skin and whites of the eyes, the main sign of jaundice, your doctor will look for other symptoms such as lumps in your abdomen and the firmness of your liver. You may also be asked about things that may heighten your risk of jaundice, such as having travelled to another country recently or having a history of drug or alcohol misuse.

You may also have to undergo liver function test, a type of blood test that helps your doctor determine if the cause of jaundice is a liver malfunction or a blocked bile duct. Other blood tests include bilirubin test, full blood count (FBC) or complete blood count (CBC) test and hepatitis A, B and C test to test for liver functioning. Urine test to test for the amount of urobilinogen in your urine can indicate the type of jaundice you have.

Imaging tests can be used to check for abnormalities in your liver or bile duct. These include ultrasound scan, CT scan, MRI scan and ERCP, which combines endoscopy and X-ray imaging. These give your doctor clearer pictures of your internal organs for him or her to make a more accurate diagnosis.

A liver biopsy, which is the removal of small tissue sample, may sometimes be needed to confirm or rule out conditions associated with liver diseases. These include inflammation, cirrhosis, cancer, and fatty liver.

Why surgery for jaundice associated with gallstones?

The treatment of jaundice typically involves addressing the underlying cause of jaundice that has been diagnosed instead of jaundice itself.

In most cases of obstructive jaundice, surgery to unblock the blocked bile duct system is recommended. It may be necessary to a section of the bile duct system or a section of the pancreas to prevent further blockages from occurring. These measures may be taken to prevent further problems which may lead to removal of your gallbladder.